HCR ManorCare, the second largest nursing home operator in the United States, filed for Chapter 11 bankruptcy protection on March 4 and will transfer ownership to its landlord, Quality Care Properties Inc. This is the latest among several signs of dysfunction in the senior housing industry.

Quality Care Properties is set to become the full owner of ManorCare’s skilled nursing, assisted living, hospice and homecare businesses across the United States. ManorCare was the nation’s largest skilled nursing facility operator during the last decade; however by 2016 it had dropped down to number 2.

The Toledo, OH based HCR ManorCare had owed its landlord more than $300 million in unpaid rent. In a filing with U.S. Bankruptcy Court in the District of Delaware, ManorCare said revenues have failed to cover monthly rent obligations since 2012 which was a year after the master lease was signed.

According to new study published in the February American Journal of Infection Control, researchers found that implementing simple hand-washing protocols in nursing homes help prevent the spread of deadly infections.

The study showed that if nursing home employees exercise the hand washing techniques that are already in practice in hospitals, the spread of deadly infections can be lowered dramatically. Lowering the spread of these infections significantly lowers death rates for nursing home residents and also lowers the amount of antibiotics that need to be prescribed to those residents.

United States nursing homes experience around 3 million infections yearly and those infections are one of the leading causes of death in nursing facilities. Infections also add around $1 billion in extra healthcare costs, according to the Association for Professionals in Infection Control and Epidemiology.

A new study released this week by the Human Rights Watch found that many nursing home residents are needlessly being given antipsychotic drugs. The 157 page report titled “They Want Docile’: How Nursing Homes in the United States Overmedicate People with Dementia,” found that approximately 179,000 people, mostly those suffering from dementia, are being given antipsychotic drugs every week in US nursing homes in an attempt to control their behavior. Facilities administer these drugs without the proper diagnosis and in many cases without obtaining informed consent from residents or their families. This is also being done in the face of an FDA warning that these drugs can almost double the risk of death for elderly dementia patients.

The drugs are being predominately used for their sedative effect, rather than any medical benefits. Nursing homes are using these drugs as a cost-effective and simple way for understaffed and overwhelmed facilities to control its residents. Many nursing homes have an inadequate amount of staff to properly care for the amount of residents in their facilities. This leads to the staff cutting corners and finding shortcuts to deal with the stress of caring for elderly dementia residents. However, it is the residents that suffer when the staff cut these corners.

Federal law requires that nursing facilities fully inform their residents about their treatment and the resident has the right to refuse that treatment. There are also some state laws that require informed consent in order for these antipsychotic medications to be given to nursing home residents. The study found that many nursing home staff members admitted to often failing to obtain consent or even to attempting to do so.

Quality rating systems and report cards for healthcare facilities are intended to give consumers more information about choosing the best quality hospital or nursing home. A study performed by Marcelo Perraillon, a Health economist of the Colorado School of Public Health at CU Anschutz, sought to determine whether the form in which that information is conveyed to consumers mattered. Perraillon assessed whether a simplified rating system used by the Nursing Home Compare website encouraged consumers to choose higher rated nursing homes.

Perraillon used a statistical method called regression continuity to illustrate that consumers do respond to public reporting of nursing homes quality information and are actually using the data to make better decisions about care. He published his findings on December 28 in the American Journal of Health Economics under the title “Consumer Response to Composite Ratings of Nursing Home Quality.”

The main finding was that nursing homes that attained an additional star, in the 1 to 5 star system, gained more admissions. However, this consumer response to this system change was not universal. Low-rated nursing homes in poorer areas which take mostly Medicaid patients still saw high admissions. Residents of those areas don’t have a lot of options when it comes to selecting a nursing home facility so they can’t benefit from the rating system in the same way. Those facilities in the poorer areas do not have the same incentive to improve their rating because admissions are already high due to the lack of choice.

According to a report by the Associated Press, an investigation into the death of a 76 year old woman at an Ohio nursing home revealed she spent roughly 8 hours outside while temperatures fell below zero. Phyllis Campbell was found dead from hypothermia on January 7 outside Hilty Memorial Home in Pandora, OH. She reportedly suffered from dementia and had a history of wandering off. “She had a history of exit seeking behaviors” and “the facility failed to ensure adequate supervision was provided,” according to a report released by the Ohio Department of Health.

That report from the Ohio Department of Health says two nursing home aides told investigators they didn’t do scheduled checks that night even though they were marked as completed. She left the building around 12:35 am and Putnam County Coroner Dr. Anne Horstman determined that she died between 1 and 2 am. She was able to exit through a door into a courtyard even though she was wearing a monitor that should have set off alarms but “at times would not sound.” She was found in the courtyard about 30 feet from its doors in the morning. The Investigations findings note that Campbell had wandered into the courtyard 2 other times during the week before she died and that she got out of her room several times that day.

One of the most difficult decisions families have to face is deciding to put a loved one in a nursing home. They want to make sure they are placing their family member in a safe environment where they will receive the proper care they need.

Many of those families rely on a government rating system to determine which facilities are the best. The Five-Star Quality Rating System employed by Centers for Medicare & Medicaid Services (CMS) is a source of information to help consumers make an informed decision when choosing a nursing home. The Medicare Nursing Home Compare website features a quality rating system that gives each nursing home a rating of between 1 (much below average) and 5 stars (much above average). The nursing home is given a star rating in three areas, self-reported staffing, self-reported quality measures, and health inspections. The facility is also given an overall star rating.

A new study of California nursing homes (the nation’s largest system of nursing homes) discovered that some nursing homes have inflated their self-reporting to improve their score in the rating system. The study was done by faculty at Florida Atlantic University and the University of Connecticut and published in the Production and Operations Management journal under the title “Winning at All Costs: Analysis of Inflation in Nursing Homes’ Rating System”. The rating system was implemented in 2008 and this study used data from 2009 to 2013.

Pennsylvania Governor Tom Wolf’s administration is putting out a new Medicaid feature that’s aimed to decrease the number of enrollees in nursing homes in the future. It is also intended to lessen a large expense for the state, which has a rapidly growing elderly population. This plan has been in place in many other states for years and provides the road map for how it can be administered in Pennsylvania.

This new feature will have a financial incentive to get enrollees the medical care and services they need in their home instead of in the nursing home, where it can be twice as expensive.

The savings under this plan will be substantial. It is around $62,000 per year for nursing home care and about half that for the care at home. There are over 50,000 Pennsylvania nursing home residents that are covered under Medicaid.

Over the last few decades there has been a movement to reduce bed rails and other variations of restraints that are used on nursing home residents. This movement has been growing ever since Congress enacted the Nursing Home Reform Act in 1987. This law included a prohibition on restraints being used for the purpose of discipline or staff convenience and not for medical purposes.

The goals of the restraints were to improve resident safety in nursing homes. However they often have the opposite result and lead to more injuries, deaths, and deprive the residents of their dignity and freedom.

Rails can be especially hazardous for residents suffering from dementia. They can fall from greater heights if they attempt to climb over them and sustain more serious injuries (especially head injuries). There are also issues with entrapment.

A 9th nursing home patient has died as a result of power outages caused by Hurricane Irma in Florida. The power outages caused the air conditioning to stop working and as a result the facilities reach dangerously hot temperatures.

Nursing home residents at the Rehabilitation Center at Hollywood Hills in Hollywood, FL were evacuated from the nursing home last Wednesday morning after the medical staff from the nearby Memorial Regional Hospital began to see nursing home patients in the emergency room with “extraordinarily high temperatures.” Some of the patients who were admitted to the hospital had temperatures of up to 106 degrees. Once hospital staff realized something was wrong at the nursing home, they began evacuating patients from the nursing home to the hospital on stretchers. A lack of backup power is being investigated as a main factor that contributed to the deaths

Around the country, facilities have been caught unprepared for emergencies that don’t come close to the severity of a hurricane like Irma that hit Florida earlier this month. Nursing home inspectors issued 2,300 violations of emergency-planning rules during the past four years. 536 of those citations were for failure to maintain comfortable and safe temperature levels for residents. In addition, a third of U.S. nursing homes have been cited for failing to inspect their generators each week or to test them monthly.

More than 1 in 4 cases of possible sexual and physical abuse against nursing home patients went unreported to police, according to a government audit. These unreported cases violate a federal law requiring immediate notification of nursing home abuse.

The Health and Human Services inspector general’s office issued an “early alert” on preliminary findings from a large sampling of cases in 33 states.

Auditors identified 134 cases in which emergency room records indicated possible sexual or physical abuse, or neglect. The incidents spanned a two-year period from 2015-2016.